| NPI | 1134194061 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: NE 16152) | 
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: IA 25166) | 
| Enumeration Date | 2006-02-22 | 
| Last Update Date | 2009-12-08 |